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Differentiated thyroid cancer (DTC) of follicular cell origin is usually an indolent tumour and with adequate initial surgery the prognosis is good. However a small proportion of patients with DTC die as a result of local invasion of cervical structures or distant metastases. Papillary thyroid cancer, the most common histological type, has a more favourable prognosis than follicular and Hürthle cell cancers.Adverse prognostic indicators include age greater than 45 years, distal metastases, extrathyroidal invasion, and primary tumour greater than 4cm in diameter.1 Several prognostic indices have been developed, but the most generally used is the TNM (tumour, nodes, metastases) classification which has been upgraded.2Thyroid cancer is relatively uncommon and is responsible for some 1% of New Zealand cancer registrations.3 In New Zealand as in other developed countries the incidence of differentiated thyroid cancer is increasing and it is uncertain whether this is due to better diagnostic testing, improved diagnostic criteria or environmental factors.The New Zealand incidence rate has risen between 1971 and 1996 from 3.7 to 6 per 100,000 females and 1.7 to 2.6 per 100,000 males. The mortality rate in the same period in contrast has shown a steady decline from 1.1 to 0.7 per 100,000 females and from 0.7 to 0.4 for males.3There have been few reports of thyroid cancer deaths, with most from large northern hemisphere referral centres.4-8 In this study we document 25 New Zealand South Island patients dying of differentiated thyroid cancer (disease-specific mortality) in the 1984-2009 interval—a 25-year experience. This review of our experience should lead to better initial management, and hopefully improved prognosis.Patients and Methods The Thyroid Clinic and Oncology Services at Christchurch Hospital are the referral centre for the northern half of the South Island of New Zealand, population 553,000 (2001 Census). Review of departmental files identified resident patients who died of differentiated thyroid cancer (DTC) of follicular cell origin in the 1984-2009 period—patients with anaplastic and poorly differentiated tumours, medullary thyroid cancer and lymphoma were excluded. Clinical data was collated and the initial histological slides of earlier patients were reviewed. Only patients dying as a direct consequence of cancer (disease-specific mortality) have been included. Twenty five patients dying of DTC were identified from our records. The study population of 25 subjects, all Caucasian, consisted of 19 patients from the North Canterbury district, 3 from South Canterbury, and 3 from the West Coast. Pathology (see Table 1)—Current WHO criteria were applied for thyroid histological classification. The original histological slides for patients diagnosed prior to 2000 were reviewed by senior pathologists, but slides were not available for Patient 3 diagnosed in 1967. Three of the earlier patients originally classified as follicular tumours were re-classified as papillary thyroid cancer-follicular variant (Pf). Results Clinical—The age, sex, year of diagnosis and clinical presentation is summarised in Table 1 where the patients (1 to 25) are listed in order of date of death—late 1984 to December 2009. The series of 25 patients (17 female, 8 male) had a median age at diagnosis of 65 years (47--86 years). Ten of the 25 patients had a long-standing history of goitre, and one goitre was very large (Patient 5). Three patients had previous treatment for cancer—two for breast cancer and one for endometrial cancer. Prior neck irradiation in adulthood had been received by two patients—one patient had radiotherapy for ipsilateral breast cancer 19 years earlier, and one patient had received three radioiodine 131I doses (total 25mCi) 30 years earlier for contralateral toxic thyroid nodule. No patient had a family history of thyroid cancer but six had a family history of goitre. Table 1. Clinical data, histological classification and TNM staging using revised (2002) classification. Patient Age/Sex Year of Diagnosis Presentation Histology Stage T N M 1 52M 1973 unilat. goitre P II 2 0 0 2 70F 1983 cervical nodes P IVC 4a 1b 1 3 48F 1967 unilat. goitre F III 3 0 0 4 62M 1984 cervical nodes P IVC 3 1b 1 5 52F 1984 huge goitre, dyspnoea F IVC 4a 0 1 6 54F 1986 unilat. goitre, dysphonia P IVA 4a 0 0 7 47M 1983 stridor, dyspnoea P IVA 4a 0 0 8 70F 1993 pleural effusion P IVC 1 1b 1 9 66F 1986 nodule F III 3 0 0 10 62F 1988 unilat. goitre P IVB 4b 0 0 11 54F 1973 unilat. goitre, dyspnoea H III 3 0 0 12 61F 1994 unilat. goitre F III 3 0 0 13 86F 1995 bone 2o F IVC x x 1 14 56F 1996 bone 2o Pf IVC x 1b 1 15 66M 1986 nodule F III 3 0 0 16 65F 1990 nodule Pf IVA 4a 0 0 17 68M 1989 unilat. goitre, dyspnoea Pf III 3 0 0 18 81F 2001 nodule, dyspnoea ʘ H IVA 4a 0 0 19 67F 1996 unilat. goitre H III 3 0 0 20 76F 2000 nodule P IVA 4a 1a 0 21 75M 2004 bone 2o H IVC 3 0 1 22 71F 2001 nodule Pf III 3 1a 0 23 60F 2000 cervical nodes P IVB 4b 1a 0 24 68M 2006 unilat. goitre P IVA 4a 1a 0 25 59M 2002 unilat. goitre ¥ H III 4a 0 0 \r\n

Summary

Abstract

Aim

To assess differentiated thyroid cancer (DTC) deaths from the northern half of New Zealands South Island.

Method

Retrospective review of Christchurch Hospital Thyroid Clinic and Oncology Department clinical records of resident patients who died of differentiated thyroid cancer of follicular cell origin over the 25-year period 1984-2009.

Results

During the 25-year study period 25 patients died from differentiated thyroid cancer. All patients (17 female, 8 male) were Caucasian, with median age 65 years (47-86 years) at presentation. Most (24/25) patients presented with advanced (15 Stage IV, 9 Stage III) disease. Three patients initially presented with cervical lymphadenopathy and four patients with distant metastasesthree patients with bone metastases, and one with a pleural effusion. The pathological classification of the tumours included 14 papillary cancers (four were follicular variants), six follicular cancers and five H 00fcrthle cell cancers. The majority of primary tumours were large (>4cm) and 11 were locally invasive. However one patient had a small (1.3cm) papillary cancer and presented with a pleural effusion. Surgical removal of the primary tumour was attempted in 24 of the 25 patients, 18 received postoperative radioiodine 131I therapy, and three had external beam radiation therapy. The median survival from diagnosis was 5.5 years (0.2-22 years) with two Stage IV patients (both with H 00fcrthle cell cancers) dying within 4 months. The majority of patients died of metastatic disease but seven died of local disease.

Conclusion

During the 25-year study period, 25 patients died of differentiated thyroid cancer which approximates to one DTC death per year in our region. The median age at diagnosis was 65 years with no patients

Author Information

Bevan Brownlie, Thyroid Physician (Retired), Nuclear Medicine Department; John Turner, Thyroid Physician, Nuclear Medicine Department; Al S Abdelaal (deceased), Radiation Oncologist, Oncology Department; Christchurch Hospital, Christchurch.

Acknowledgements

This study has been possible with the assistance of anatomical pathologists Dr L A Hunter and Dr J Gearry, and our surgical and oncology colleagues. The authors also acknowledge the editorial assistance of Sue Moran and secretarial staff; particularly Bridget Ginley.

Correspondence

Dr B Brownlie, Nuclear Medicine Department, 2nd Floor Riverside Block, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand. Fax: +64 (0)3 3640869

Correspondence Email

janet.adcock@cdhb.govt.nz

Competing Interests

None known.

Baloch ZW, Li Volsi VA. Prognostic factors in well-differentiated follicular derived carcinoma and medullary thyroid cancer. Thyroid. 2001;11:637-45.AJCC Cancer Staging Handbook. TNM classification of malignant tumors. Sixth edition. New York: Springer 2002; 89-98.Thyroid cancer in: Ministry of Health. Cancer in New Zealand: trends and projections. Wellington: 2002; 315-23.Eustatia-Rutten CF, Corssmit EP, Biermasz NR, et al. Survival and death causes in differentiated thyroid cancer. J Clin Endocrinol Metab. 2006; 91:313-19.Wu H-S, Young MT, Ituarte PH, et al. Death from thyroid cancer of follicular cell origin. J Am Coll Surg. 2000; 191:600-06.Beasley NJ, Walfish PG, Witterick I, et al. Cause of death in patients with well differentiated thyroid cancer. Laryngoscope. 2001; 111:989-91.Kitamura Y, Shimizu K, Nagahama M, et al. Immediate causes of death in thyroid carcinoma: clinicopathological analysis of 161 fatal cases. J Clin Endocrinol Metab. 1999;84:4043-49.Eichhorn W, Tabler H, Lippold R, et al. Prognostic factors determining long-term survival in well-differentiated thyroid cancer: an analysis of 484 patients. Thyroid. 2003;13:949-58.Grillo HC, Suen HC, Mathisen DJ, et al. Resectional management of thyroid carcinoma invading the airway. Ann Thorac Surg. 1992; 54:3-10.Brownlie B, Mercer P, Turner J, et al. Thyroid malignancies: a New Zealand South Island thyroid clinic experience 1995-2006. N Z Med J. 2008;121:36-45.Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997;194:474-76.Vassilopoulou-Sellin R, Sneige N. Pleural effusion in patients with differentiated papillary thyroid cancer. South Med J. 1994;87:1111-16.British Thyroid Association, Royal College of Physicians. Guidelines for the management of thyroid cancer. (Perros P, ed). 2nded. London 2007.Cooper DS, Doherty GM, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. The American Thyroid Association Guidelines. Thyroid 2006; 16:119-41.Pacini F, Schlumberger M, Harmer C, et al. Postsurgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report. Eur J Endocrinol. 2005;153:651-59.Wilson PC, Millar BM, Brierley JD. The management of advanced thyroid cancer. Clin Oncol. 2004;16:561-68.Stojadinovic A, Ghossein RA, Hoos A, et al. H 00fcrthle cell carcinoma: a critical histopathological appraisal. J Clin Oncol. 2001;19:2616-25.Besic N, Vidergar-Kralj B, Frkovic-Grazio S, et al. The role of radioactive iodine in the treatment of H 00fcrthle cell carcinoma of the thyroid. Thyroid. 2003;13:577-84.Harness JK, McLeod MK, Thompson NW, et al. Deaths due to differentiated thyroid cancer: a 46 year perspective. World J Surg. 1988;12:623-29.Verkooijen RB, Smit JW, Romijn JA, et al. The incidence of second primary tumors in thyroid cancer patients is increased, but not related to treatment of thyroid cancer. Eur J Endocrinol. 2006;155:801-06.Eustatia-Rutten CF, Romijn JA, Guijt MJ, et al. Outcome of palliative embolization of bone metastases in differentiated thyroid cancer. J Clin Endocrinol Metab. 2003;88:3184-89.Chen L, Shen Y, Luo Q, et al. Response to Sorafenib at a low dose in patients with radioiodine-refractory pulmonary metastases from papillary thyroid carcinoma. Thyroid. 2011;21:119-24.

For the PDF of this article,
contact nzmj@nzma.org.nz

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Differentiated thyroid cancer (DTC) of follicular cell origin is usually an indolent tumour and with adequate initial surgery the prognosis is good. However a small proportion of patients with DTC die as a result of local invasion of cervical structures or distant metastases. Papillary thyroid cancer, the most common histological type, has a more favourable prognosis than follicular and Hürthle cell cancers.Adverse prognostic indicators include age greater than 45 years, distal metastases, extrathyroidal invasion, and primary tumour greater than 4cm in diameter.1 Several prognostic indices have been developed, but the most generally used is the TNM (tumour, nodes, metastases) classification which has been upgraded.2Thyroid cancer is relatively uncommon and is responsible for some 1% of New Zealand cancer registrations.3 In New Zealand as in other developed countries the incidence of differentiated thyroid cancer is increasing and it is uncertain whether this is due to better diagnostic testing, improved diagnostic criteria or environmental factors.The New Zealand incidence rate has risen between 1971 and 1996 from 3.7 to 6 per 100,000 females and 1.7 to 2.6 per 100,000 males. The mortality rate in the same period in contrast has shown a steady decline from 1.1 to 0.7 per 100,000 females and from 0.7 to 0.4 for males.3There have been few reports of thyroid cancer deaths, with most from large northern hemisphere referral centres.4-8 In this study we document 25 New Zealand South Island patients dying of differentiated thyroid cancer (disease-specific mortality) in the 1984-2009 interval—a 25-year experience. This review of our experience should lead to better initial management, and hopefully improved prognosis.Patients and Methods The Thyroid Clinic and Oncology Services at Christchurch Hospital are the referral centre for the northern half of the South Island of New Zealand, population 553,000 (2001 Census). Review of departmental files identified resident patients who died of differentiated thyroid cancer (DTC) of follicular cell origin in the 1984-2009 period—patients with anaplastic and poorly differentiated tumours, medullary thyroid cancer and lymphoma were excluded. Clinical data was collated and the initial histological slides of earlier patients were reviewed. Only patients dying as a direct consequence of cancer (disease-specific mortality) have been included. Twenty five patients dying of DTC were identified from our records. The study population of 25 subjects, all Caucasian, consisted of 19 patients from the North Canterbury district, 3 from South Canterbury, and 3 from the West Coast. Pathology (see Table 1)—Current WHO criteria were applied for thyroid histological classification. The original histological slides for patients diagnosed prior to 2000 were reviewed by senior pathologists, but slides were not available for Patient 3 diagnosed in 1967. Three of the earlier patients originally classified as follicular tumours were re-classified as papillary thyroid cancer-follicular variant (Pf). Results Clinical—The age, sex, year of diagnosis and clinical presentation is summarised in Table 1 where the patients (1 to 25) are listed in order of date of death—late 1984 to December 2009. The series of 25 patients (17 female, 8 male) had a median age at diagnosis of 65 years (47--86 years). Ten of the 25 patients had a long-standing history of goitre, and one goitre was very large (Patient 5). Three patients had previous treatment for cancer—two for breast cancer and one for endometrial cancer. Prior neck irradiation in adulthood had been received by two patients—one patient had radiotherapy for ipsilateral breast cancer 19 years earlier, and one patient had received three radioiodine 131I doses (total 25mCi) 30 years earlier for contralateral toxic thyroid nodule. No patient had a family history of thyroid cancer but six had a family history of goitre. Table 1. Clinical data, histological classification and TNM staging using revised (2002) classification. Patient Age/Sex Year of Diagnosis Presentation Histology Stage T N M 1 52M 1973 unilat. goitre P II 2 0 0 2 70F 1983 cervical nodes P IVC 4a 1b 1 3 48F 1967 unilat. goitre F III 3 0 0 4 62M 1984 cervical nodes P IVC 3 1b 1 5 52F 1984 huge goitre, dyspnoea F IVC 4a 0 1 6 54F 1986 unilat. goitre, dysphonia P IVA 4a 0 0 7 47M 1983 stridor, dyspnoea P IVA 4a 0 0 8 70F 1993 pleural effusion P IVC 1 1b 1 9 66F 1986 nodule F III 3 0 0 10 62F 1988 unilat. goitre P IVB 4b 0 0 11 54F 1973 unilat. goitre, dyspnoea H III 3 0 0 12 61F 1994 unilat. goitre F III 3 0 0 13 86F 1995 bone 2o F IVC x x 1 14 56F 1996 bone 2o Pf IVC x 1b 1 15 66M 1986 nodule F III 3 0 0 16 65F 1990 nodule Pf IVA 4a 0 0 17 68M 1989 unilat. goitre, dyspnoea Pf III 3 0 0 18 81F 2001 nodule, dyspnoea ʘ H IVA 4a 0 0 19 67F 1996 unilat. goitre H III 3 0 0 20 76F 2000 nodule P IVA 4a 1a 0 21 75M 2004 bone 2o H IVC 3 0 1 22 71F 2001 nodule Pf III 3 1a 0 23 60F 2000 cervical nodes P IVB 4b 1a 0 24 68M 2006 unilat. goitre P IVA 4a 1a 0 25 59M 2002 unilat. goitre ¥ H III 4a 0 0 \r\n

Summary

Abstract

Aim

To assess differentiated thyroid cancer (DTC) deaths from the northern half of New Zealands South Island.

Method

Retrospective review of Christchurch Hospital Thyroid Clinic and Oncology Department clinical records of resident patients who died of differentiated thyroid cancer of follicular cell origin over the 25-year period 1984-2009.

Results

During the 25-year study period 25 patients died from differentiated thyroid cancer. All patients (17 female, 8 male) were Caucasian, with median age 65 years (47-86 years) at presentation. Most (24/25) patients presented with advanced (15 Stage IV, 9 Stage III) disease. Three patients initially presented with cervical lymphadenopathy and four patients with distant metastasesthree patients with bone metastases, and one with a pleural effusion. The pathological classification of the tumours included 14 papillary cancers (four were follicular variants), six follicular cancers and five H 00fcrthle cell cancers. The majority of primary tumours were large (>4cm) and 11 were locally invasive. However one patient had a small (1.3cm) papillary cancer and presented with a pleural effusion. Surgical removal of the primary tumour was attempted in 24 of the 25 patients, 18 received postoperative radioiodine 131I therapy, and three had external beam radiation therapy. The median survival from diagnosis was 5.5 years (0.2-22 years) with two Stage IV patients (both with H 00fcrthle cell cancers) dying within 4 months. The majority of patients died of metastatic disease but seven died of local disease.

Conclusion

During the 25-year study period, 25 patients died of differentiated thyroid cancer which approximates to one DTC death per year in our region. The median age at diagnosis was 65 years with no patients

Author Information

Bevan Brownlie, Thyroid Physician (Retired), Nuclear Medicine Department; John Turner, Thyroid Physician, Nuclear Medicine Department; Al S Abdelaal (deceased), Radiation Oncologist, Oncology Department; Christchurch Hospital, Christchurch.

Acknowledgements

This study has been possible with the assistance of anatomical pathologists Dr L A Hunter and Dr J Gearry, and our surgical and oncology colleagues. The authors also acknowledge the editorial assistance of Sue Moran and secretarial staff; particularly Bridget Ginley.

Correspondence

Dr B Brownlie, Nuclear Medicine Department, 2nd Floor Riverside Block, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand. Fax: +64 (0)3 3640869

Correspondence Email

janet.adcock@cdhb.govt.nz

Competing Interests

None known.

Baloch ZW, Li Volsi VA. Prognostic factors in well-differentiated follicular derived carcinoma and medullary thyroid cancer. Thyroid. 2001;11:637-45.AJCC Cancer Staging Handbook. TNM classification of malignant tumors. Sixth edition. New York: Springer 2002; 89-98.Thyroid cancer in: Ministry of Health. Cancer in New Zealand: trends and projections. Wellington: 2002; 315-23.Eustatia-Rutten CF, Corssmit EP, Biermasz NR, et al. Survival and death causes in differentiated thyroid cancer. J Clin Endocrinol Metab. 2006; 91:313-19.Wu H-S, Young MT, Ituarte PH, et al. Death from thyroid cancer of follicular cell origin. J Am Coll Surg. 2000; 191:600-06.Beasley NJ, Walfish PG, Witterick I, et al. Cause of death in patients with well differentiated thyroid cancer. Laryngoscope. 2001; 111:989-91.Kitamura Y, Shimizu K, Nagahama M, et al. Immediate causes of death in thyroid carcinoma: clinicopathological analysis of 161 fatal cases. J Clin Endocrinol Metab. 1999;84:4043-49.Eichhorn W, Tabler H, Lippold R, et al. Prognostic factors determining long-term survival in well-differentiated thyroid cancer: an analysis of 484 patients. Thyroid. 2003;13:949-58.Grillo HC, Suen HC, Mathisen DJ, et al. Resectional management of thyroid carcinoma invading the airway. Ann Thorac Surg. 1992; 54:3-10.Brownlie B, Mercer P, Turner J, et al. Thyroid malignancies: a New Zealand South Island thyroid clinic experience 1995-2006. N Z Med J. 2008;121:36-45.Shaha AR, Shah JP, Loree TR. Differentiated thyroid cancer presenting initially with distant metastasis. Am J Surg. 1997;194:474-76.Vassilopoulou-Sellin R, Sneige N. Pleural effusion in patients with differentiated papillary thyroid cancer. South Med J. 1994;87:1111-16.British Thyroid Association, Royal College of Physicians. Guidelines for the management of thyroid cancer. (Perros P, ed). 2nded. London 2007.Cooper DS, Doherty GM, et al. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. The American Thyroid Association Guidelines. Thyroid 2006; 16:119-41.Pacini F, Schlumberger M, Harmer C, et al. Postsurgical use of radioiodine (131I) in patients with papillary and follicular thyroid cancer and the issue of remnant ablation: a consensus report. Eur J Endocrinol. 2005;153:651-59.Wilson PC, Millar BM, Brierley JD. The management of advanced thyroid cancer. Clin Oncol. 2004;16:561-68.Stojadinovic A, Ghossein RA, Hoos A, et al. H 00fcrthle cell carcinoma: a critical histopathological appraisal. J Clin Oncol. 2001;19:2616-25.Besic N, Vidergar-Kralj B, Frkovic-Grazio S, et al. The role of radioactive iodine in the treatment of H 00fcrthle cell carcinoma of the thyroid. Thyroid. 2003;13:577-84.Harness JK, McLeod MK, Thompson NW, et al. Deaths due to differentiated thyroid cancer: a 46 year perspective. World J Surg. 1988;12:623-29.Verkooijen RB, Smit JW, Romijn JA, et al. The incidence of second primary tumors in thyroid cancer patients is increased, but not related to treatment of thyroid cancer. Eur J Endocrinol. 2006;155:801-06.Eustatia-Rutten CF, Romijn JA, Guijt MJ, et al. Outcome of palliative embolization of bone metastases in differentiated thyroid cancer. J Clin Endocrinol Metab. 2003;88:3184-89.Chen L, Shen Y, Luo Q, et al. Response to Sorafenib at a low dose in patients with radioiodine-refractory pulmonary metastases from papillary thyroid carcinoma. Thyroid. 2011;21:119-24.

For the PDF of this article,
contact nzmj@nzma.org.nz

View Article PDF

Differentiated thyroid cancer (DTC) of follicular cell origin is usually an indolent tumour and with adequate initial surgery the prognosis is good. However a small proportion of patients with DTC die as a result of local invasion of cervical structures or distant metastases. Papillary thyroid cancer, the most common histological type, has a more favourable prognosis than follicular and Hürthle cell cancers.Adverse prognostic indicators include age greater than 45 years, distal metastases, extrathyroidal invasion, and primary tumour greater than 4cm in diameter.1 Several prognostic indices have been developed, but the most generally used is the TNM (tumour, nodes, metastases) classification which has been upgraded.2Thyroid cancer is relatively uncommon and is responsible for some 1% of New Zealand cancer registrations.3 In New Zealand as in other developed countries the incidence of differentiated thyroid cancer is increasing and it is uncertain whether this is due to better diagnostic testing, improved diagnostic criteria or environmental factors.The New Zealand incidence rate has risen between 1971 and 1996 from 3.7 to 6 per 100,000 females and 1.7 to 2.6 per 100,000 males. The mortality rate in the same period in contrast has shown a steady decline from 1.1 to 0.7 per 100,000 females and from 0.7 to 0.4 for males.3There have been few reports of thyroid cancer deaths, with most from large northern hemisphere referral centres.4-8 In this study we document 25 New Zealand South Island patients dying of differentiated thyroid cancer (disease-specific mortality) in the 1984-2009 interval—a 25-year experience. This review of our experience should lead to better initial management, and hopefully improved prognosis.Patients and Methods The Thyroid Clinic and Oncology Services at Christchurch Hospital are the referral centre for the northern half of the South Island of New Zealand, population 553,000 (2001 Census). Review of departmental files identified resident patients who died of differentiated thyroid cancer (DTC) of follicular cell origin in the 1984-2009 period—patients with anaplastic and poorly differentiated tumours, medullary thyroid cancer and lymphoma were excluded. Clinical data was collated and the initial histological slides of earlier patients were reviewed. Only patients dying as a direct consequence of cancer (disease-specific mortality) have been included. Twenty five patients dying of DTC were identified from our records. The study population of 25 subjects, all Caucasian, consisted of 19 patients from the North Canterbury district, 3 from South Canterbury, and 3 from the West Coast. Pathology (see Table 1)—Current WHO criteria were applied for thyroid histological classification. The original histological slides for patients diagnosed prior to 2000 were reviewed by senior pathologists, but slides were not available for Patient 3 diagnosed in 1967. Three of the earlier patients originally classified as follicular tumours were re-classified as papillary thyroid cancer-follicular variant (Pf). Results Clinical—The age, sex, year of diagnosis and clinical presentation is summarised in Table 1 where the patients (1 to 25) are listed in order of date of death—late 1984 to December 2009. The series of 25 patients (17 female, 8 male) had a median age at diagnosis of 65 years (47--86 years). Ten of the 25 patients had a long-standing history of goitre, and one goitre was very large (Patient 5). Three patients had previous treatment for cancer—two for breast cancer and one for endometrial cancer. Prior neck irradiation in adulthood had been received by two patients—one patient had radiotherapy for ipsilateral breast cancer 19 years earlier, and one patient had received three radioiodine 131I doses (total 25mCi) 30 years earlier for contralateral toxic thyroid nodule. No patient had a family history of thyroid cancer but six had a family history of goitre. Table 1. Clinical data, histological classification and TNM staging using revised (2002) classification. Patient Age/Sex Year of Diagnosis Presentation Histology Stage T N M 1 52M 1973 unilat. goitre P II 2 0 0 2 70F 1983 cervical nodes P IVC 4a 1b 1 3 48F 1967 unilat. goitre F III 3 0 0 4 62M 1984 cervical nodes P IVC 3 1b 1 5 52F 1984 huge goitre, dyspnoea F IVC 4a 0 1 6 54F 1986 unilat. goitre, dysphonia P IVA 4a 0 0 7 47M 1983 stridor, dyspnoea P IVA 4a 0 0 8 70F 1993 pleural effusion P IVC 1 1b 1 9 66F 1986 nodule F III 3 0 0 10 62F 1988 unilat. goitre P IVB 4b 0 0 11 54F 1973 unilat. goitre, dyspnoea H III 3 0 0 12 61F 1994 unilat. goitre F III 3 0 0 13 86F 1995 bone 2o F IVC x x 1 14 56F 1996 bone 2o Pf IVC x 1b 1 15 66M 1986 nodule F III 3 0 0 16 65F 1990 nodule Pf IVA 4a 0 0 17 68M 1989 unilat. goitre, dyspnoea Pf III 3 0 0 18 81F 2001 nodule, dyspnoea ʘ H IVA 4a 0 0 19 67F 1996 unilat. goitre H III 3 0 0 20 76F 2000 nodule P IVA 4a 1a 0 21 75M 2004 bone 2o H IVC 3 0 1 22 71F 2001 nodule Pf III 3 1a 0 23 60F 2000 cervical nodes P IVB 4b 1a 0 24 68M 2006 unilat. goitre P IVA 4a 1a 0 25 59M 2002 unilat. goitre ¥ H III 4a 0 0 \r\n

Summary

Abstract

Aim

To assess differentiated thyroid cancer (DTC) deaths from the northern half of New Zealands South Island.

Method

Retrospective review of Christchurch Hospital Thyroid Clinic and Oncology Department clinical records of resident patients who died of differentiated thyroid cancer of follicular cell origin over the 25-year period 1984-2009.

Results

During the 25-year study period 25 patients died from differentiated thyroid cancer. All patients (17 female, 8 male) were Caucasian, with median age 65 years (47-86 years) at presentation. Most (24/25) patients presented with advanced (15 Stage IV, 9 Stage III) disease. Three patients initially presented with cervical lymphadenopathy and four patients with distant metastasesthree patients with bone metastases, and one with a pleural effusion. The pathological classification of the tumours included 14 papillary cancers (four were follicular variants), six follicular cancers and five H 00fcrthle cell cancers. The majority of primary tumours were large (>4cm) and 11 were locally invasive. However one patient had a small (1.3cm) papillary cancer and presented with a pleural effusion. Surgical removal of the primary tumour was attempted in 24 of the 25 patients, 18 received postoperative radioiodine 131I therapy, and three had external beam radiation therapy. The median survival from diagnosis was 5.5 years (0.2-22 years) with two Stage IV patients (both with H 00fcrthle cell cancers) dying within 4 months. The majority of patients died of metastatic disease but seven died of local disease.

Conclusion

During the 25-year study period, 25 patients died of differentiated thyroid cancer which approximates to one DTC death per year in our region. The median age at diagnosis was 65 years with no patients

Author Information

Bevan Brownlie, Thyroid Physician (Retired), Nuclear Medicine Department; John Turner, Thyroid Physician, Nuclear Medicine Department; Al S Abdelaal (deceased), Radiation Oncologist, Oncology Department; Christchurch Hospital, Christchurch.

Acknowledgements

This study has been possible with the assistance of anatomical pathologists Dr L A Hunter and Dr J Gearry, and our surgical and oncology colleagues. The authors also acknowledge the editorial assistance of Sue Moran and secretarial staff; particularly Bridget Ginley.

Correspondence

Dr B Brownlie, Nuclear Medicine Department, 2nd Floor Riverside Block, Christchurch Hospital, Private Bag 4710, Christchurch, New Zealand. Fax: +64 (0)3 3640869

Correspondence Email

janet.adcock@cdhb.govt.nz

Competing Interests

None known.

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